Dems campaign on Medicaid increase

Democrats have found a big piece of Obamacare that nearly all factions of their party can back — and they say it’ll be a winning issue on the campaign trail this fall.

Even some of the Democrats running for reelection in red states are embracing the Affordable Care Act’s optional Medicaid expansion and, along with their compatriots, pressuring Republican governors and legislatures to do the same.

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This growing support to expand Medicaid comes as Democrats feel increasingly comfortable touting the health care law, a slow change buoyed this spring by the positive news of Obamacare’s 8 million enrollees. They frame it as an issue that forces Republicans to explain why they want to deny health care access to poor people at zero cost to states — at least for the first three years while the federal government picks up the entire tab.

Moreover, polls show that Medicaid expansion could provide a big political boost. It’s far more popular than Obamacare itself.

“We’re going to have, for the first time in a little while, Democrats in vulnerable states and safe states all speaking with one voice in part because of the political momentum growing behind Medicaid expansion,” Sen. Chris Murphy (D-Conn.), the Senate Democrats’ point person on health care messaging, told POLITICO in an interview.

Murphy and other Senate Democrats are asking 18 Republican governors to agree to expand the program in a letter to be released Wednesday.

“There is a fundamental inequity playing out in your state and others that have chosen to not expand this basic health care coverage,” the 20 Democrats write in the letter. “A political difference should not result in almost 6 million Americans falling into a coverage gap because their income is too high for Medicaid coverage, but below the level for a premium tax credit for coverage through a Marketplace plan.”

However, even four years after Obamacare’s passage, Murphy admits that Democrats still have a hard time talking about it, although the law represents the pinnacle of decades of attempts by the party to pass a universal health care bill.

“Having cowered in a corner for a good part of the last four years, it’s hard to change your behavior,” he said. “It’s hard for people to immediately pivot from being on the defense in the fall [as HealthCare.gov crashed] to being on the offense. The news went from terrible to great in an instant, and sometimes it’s hard for your strategy to catch up.”

Medicaid is one aspect of the law where Democrats are falling into line — more so than with many other elements. In some cases, they’re touting Medicaid on its own, with little mention of Obamacare.

The Affordable Care Act required states to expand Medicaid to 138 percent of the federal poverty level, but a 2012 decision by the Supreme Court instead made that optional for states. So far, the District of Columbia and 26 states have chosen to expand their programs. Most of those states are controlled by Democrats.

Sen. Kay Hagan of North Carolina, one of the most vulnerable Democrats running in a state where the health care law is not particularly popular, pushed Sylvia Mathews Burwell to explain the benefits of Medicaid expansion in one of the nominee’s confirmation hearings to lead Health and Human Services.

Hagan will continue to press for Medicaid expansion in her campaign against North Carolina House Speaker Thom Tillis, according to spokeswoman Sadie Weiner. “Like all of the issues in this race, health care is a stark contrast between Kay’s record of pushing for common-sense fixes to this law and Thom Tillis, who brags about rejecting health care for 500,000 people,” Weiner said.

Sen. Mary Landrieu, another Democrat facing voters this fall, has been saying that Louisianans who find themselves without Medicaid because of lawmakers’ decision not to expand are in the “Jindal gap,” a reference to Republican Gov. Bobby Jindal, an expansion opponent.

Sen. Mark Begich (D-Alaska) has encouraged his governor to expand the program there, and Michelle Nunn, the Democrat running for the open Senate seat in Georgia, has supported expansion, too.

To be sure, it’s not universal. Alison Lundergan Grimes, who is trying to retire Senate Republican leader Mitch McConnell in Kentucky, has said that she wants to “fix” the health care law but hasn’t weighed in on Medicaid specifically.

Republicans aren’t universal in their opposition, either, particularly in states that have already expanded or are in the process of doing so. Terri Lynn Land, the Republican Senate candidate in Michigan, praised her Republican governor’s decision to expand Medicaid.

In New Hampshire, which just approved Medicaid expansion, Senate candidate Scott Brown has said that eligible residents could be covered in another way.

“You can incorporate any of the considerations for those people on Medicaid expansion into a plan that works for us,” he told The Boston Globe recently. Brown has repeatedly refused to directly say whether he approves or supports New Hampshire’s move.

But overall, Republicans have largely scoffed at expanding Medicaid, arguing that it is fruitless to add people to a broken program that will eventually cost the states more money. These GOP critics worry that there is nothing to prevent the federal government from pushing all of the cost to the states in the future.

The Democrats’ argument for expansion is easy: It’s giving more people care in an already familiar system, they say. And without Medicaid, some people would have no health coverage at all. In many states, hospitals are also aggressively pushing expansion so that more of their customers have coverage and don’t need their charity care.

Polls suggest that Medicaid expansion could be a political winner. A March survey by the Kaiser Family Foundation found that 74 percent of respondents had a favorable view of Medicaid expansion — far more than the 38 percent who had a favorable opinion of Obamacare overall.

At the same time, there are obstacles: That survey also found that only 60 percent of people even knew about the Medicaid expansion piece of the law.